3. Primary dysmenorrhea, which is defined
as painful menses in women with
normal pelvic anatomy, usually begins
during adolescence. It is characterized
by crampy pelvic pain beginning shortly
before or at the onset of menses and
lasting one to three days.
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4. The prevalence of dysmenorrhea is highest
in adolescent women, with estimates
ranging from 20 to 90 percent, depending
on the measurement method used.
A longitudinal study of a representative
cohort of Swedish women found a
prevalence of dysmenorrhea of 90 percent
in women 19 years of age and 67 percent
in women 24 years of age.
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5. Dysmenorrhea is thought to be caused by the
release of prostaglandins in the menstrual fluid,
which causes uterine contractions and pain.
Vasopressin also may play a role by increasing
uterine contractility and causing ischemic pain as a
result of vasoconstriction.
– Elevated vasopressin levels have been reported in
women with primary dysmenorrhea.
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6. Age < 20 years
Attempts to lose weight
Depression/anxiety
Disruption of social networks
Heavy menses
Nulliparity
Smoking
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7. History and physical examination
– perform only an abdominal examination in young
adolescents with a typical history who have never been
sexually active
Always R/O secondary dysmenorrhea
– Pelvic mass, abnormal vaginal discharge…
Ultrasonography
laparoscopy or laparotomy with biopsy
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8. A = consistent, good-quality, patient-oriented
evidence
B = inconsistent or limited quality patient-oriented
evidence
C = consensus, disease-oriented evidence, usual
practice, opinion, or case series.
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13. NSAIDs are the initial therapy of choice in patients
with presumptive primary dysmenorrhea.Because
all NSAIDs are equal in efficacy, agent selection
should be guided by cost, convenience, and patient
preference,with ibuprofen or naproxen being a
good choice for most patients.
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14. American Family Physician January 15, 2005 Volume 71,
Number 2
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